Shit, Shit and Shit! #7

Which is something I have had a very difficult time doing since I have been on those “Amazing Narcotic Pain Meds!” and a 24 hour protein only diet which didn’t help much!

So lets start there…. Shit #1

A PET/CT scan takes pictures of your body in slices…much like a slinky, puts them together and can display them in a 3D image. You arrive to decided facility, empty your bladder, an IV accessed (which again was hard in my only available arm. I felt really bad for the technician because she was new, got super nervous feeling like she was causing me pain and kept apologizing. It did hurt regardless of how much percocet I took before but I couldn’t let her know that…. poor thing could’ve scared her for life! I helped her find a vein that wasn’t ‘valvey’ and we moved on). You are given a radioactive tracer/substance very similar to sugar. Through your body’s natural metabolism this substance binds itself or is absorbed by cancer cells thus causing them to glow brighter on x-ray images.

To ensure you have the most accurate scan possible there is a special diet that must be followed to allow the fludeoxyglucose (FDG) to do its job and since its is glucose based that means for 24 hrs prior to PET/CT you are on a strict PROTEIN AND WATER ONLY diet. No vegetables or fruit, no pasta, no fruit juices, no coffee or morning donuts with coffee, no yogurt or cheese and most importantly no wine! Water and pure protein only up to 6 hours before the scan when you can have only water ! I know how exciting this is so please try to hold back any display of happy energy because I’d really like to know how I am supposed to poop while ingesting this special diet and my much needed pain medication?!?!

Shit #2: I had my PET/CT on Tuesday 04/08 and met with The Blood Guy the next day. It was a late afternoon appointment, his last one of the day. Mom and Shauna were there and I had explained to Mom we would be talking about some serious issues, things I think would be incredibly difficult to hear about my child if I had one. Unfortunately, I couldn’t prepare her or my sister enough to hear what The Blood Guy and I read on my report. I surely wasn’t  ready for this and by the look on his face neither was he.

First a pathophysiology lesson: remember that radioactive tracer mentioned before? It is measured in it’s uptake value SUV (standardized uptake value). That means how much was absorbed into the cells to make them glow.  Anything above a 3.0 is pretty much a definitive cancer diagnosis (DX). (of course, there are other variables that play into a CA DX but that is a another A&P/Pathophysiology lesson entirely)

In my chest:

  • There is a superior mediastinum lymphnode (sternum area) measuring 9MM with SUV an of 3.5.
  • A precarinal lymphnode (sternum area) with an SUV of 3.2.
  • There is focal FDG activity with SUV of 4.2 in the left hilum (sternum area).
  • I still have a small to moderate left lung pleural effusion (fluid in my lung cavity).

Abdominal:

  • SUV of 4.9 in the left lateral abdominal wall adjacent to the left 10th rib. The Blood Guy and I fully expected there to be some continued swelling on the left side. Still worrisome however at this SUV level.

Bones:

  • There is a new lytic lesion in the right ilium (hip) SUV of 3.9
  • A new tiny lytic lesion in the left sacrum (tail bone) unidentifiable SUV because it is so small.
  • Several lytic lesions in the spine: no number or SUV identified on report
  • A focal lytic lesion in the left T-10 vertebrae SUV 4.4
  • Left pedicle L3 (specific part of the vertebrae) lytrc lesion  SUV 4.2
  • Subtle lytic lesion in the posterior 10 rib SUV 4.2 (hey, didn’t we just sew that to #8 rib for stability?

…. and the last sentence of this image report, the silver lining,  the highlight, and personally my favorite medical documentation EVER (and since my career is in medical documentation please pay attention)!

” There is an old fracture of the left lateral 9th rib.”

ta-da.

HAHAHAHAHAhHAHHHHAHAHAHAAAAHHHAA! Seriously!? Didn’t I just have, like 3 weeks ago, that rib forcibly taken from my body? The 7 inch incision/scar across my back says I did! If you asked my body and she could speak (and I believe she does), I imagine a vocabulary of new cuss words would describe our left 9th rib being ripped from our precious being!

The Blood Guy and I got to that part of the report and we looked at each other, my expression clearly perplexed (really?) and he just shook his head with a smile implying please don’t go there,  please don’t ask me….. LOL! Cracks me up every time I think about it. 🙂

So, to sum things up:

1. Multiple new lytic lesions in the axial skeleton consistent with metatstatic disease. No sclerotic lesions are identified explaining multiple negative bone scans.

2. Increased activity in mediastinum and left hilum, suspicious for metastatic disease.

3. Small to moderate left pleural effusion with adjacent airspace disease, likely atelectasis (collapsed lung).

After reading this report with The Blood Guy, tears welling up I looked at my sister and my mom. Both of whom have no idea what I’m reading as a word has not been spoken. I grab the report and start to read it again and again while the Blood Guy attempts to explain to my family what is going on. Instantly, I see tears stream down my mother’s face whose expression of confusion and fear as she desperately tries to comprehend that her daughter, at 40 years old, has Stage IV Advanced Metastatic Breast Cancer. And my sister, feverishly taking notes, still not sure what’s happening as she is so focused on filling in the blanks on my 2 pages of very descriptive questions. Shauna has been to all of my appointments since the beginning 2 1/2 years ago (thank you sis).

I numbly sit there watching my sister and mom cry, asking questions in between catching their breath. Shauna doing her best to write everything down, I find that The Blood Guy is holding my hand. He looks at me checking to see I’m ok.  He’s never seen me so quiet before, waiting for me to interject any minute while he continues to answer Mom’s and Shauna’s questions. I read that report 5 times, heard the loudest crack in my head, a noise I’ve never experience before and then thought to myself ‘well shit.’

Shit #3

The Senokot finally kicked in and on Thursday I pooped. 🙂

 

 

 

 

 

 

 

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